OSCE Explanations

Question 1

Key areas to cover in a HIV consent station? (5)

Answer 1

1) Benefits of early HIV diagnosis - prognosis improves earlier treatment is commenced
2) No longer death sentence, many people can go on to lead nearly normal lives
3) Either point of care test (result in 30mins) or take about 3 days to come back - but note if caught in last 1-3 months (depending on test) may not be picked up so will need a repeat test
4) All positive results need repeat test to confirm

(If applicable can offer post-exposure prophylaxis (PEP) if had high risk sexual contact in last 72 hrs, although earlier the better)

Question 2

How is Duchenne Muscular Dystrophy inherited?

Answer 2

X-linked recessive
(rarely affects females, no MtoM transmission)

Son of a carrier female has 50% of being affected, daughter of carrier female has 50% chance of being carrier

Question 3

What two things should a patient know about a bone marrow biopsy?

Answer 3

Done under LA (stay awake)

Can be given sedation (need to stay for a few hours afterwards)

Question 4

What lifestyle factors should be covered in all diabetic consultations where the patient has had one or more hypo’s?

Answer 4

DVLA must inform!

Don’t operate machinery etc.

Question 5

What should a patient be counselled regarding DMD prognosis?

Answer 5

Progressive, no cure

Life-limiting and will mean a shorter life (30’s for boys now with DMD)

Question 6

Name 5 management counselling points in eczema?

Answer 6

Con- Avoid wool, extremes of temp, short nails, hydrated skin
Med- Emollients liberally, steroids when needed apply 1-2/day

Make sure know flare up syx (redness, swelling, itching worse) and infection (weeping, pustules, crusts etc)

Question 7

Coeliac disease, in OSCE style give:
Cause
3 symptoms
Investigation 
Management 
Complications

Answer 7

Cause: Autoimmune, but unknown why
Symptoms: Diarrhoea, abdo pain, bloating
Investigation: TTG (bloods) and possible biopsy but not all - make sure on gluten for at least 6 weeks!
Management: Avoid pasta/ bread/ cakes/ cereals
- Charities a good source to find gluten free food

Complications: Osteoporosis/ anaemia/ small increased cancer risk (CRC)

Question 8

HRT, OSCE style give:
3 Alternatives 
Risks (3)
Benefits (3)
How to take (3 points)

Answer 8

Alternatives: Exercise, diet, weight loss, antidepressants
Risks: Increased breast, endometrial and clot risk
Benefit: Lower CRC, osteoporosis risk plus symptom control
How to take: Patch, tablet, cream, pessary
- Cyclical or continous (needs 1yr post LMP)
- Take for a few years until menopausal symptoms settle

Question 9

What are the main risks of COCP?

Answer 9

Clots
Increased risk of breast and cervical cancer
Mood changes

Question 10

What are the main benefits of COCP?

Answer 10

Lighter and less painful periods
Less acne, cysts and benign breast disease
Less ovarian, endometrial and colorectal cancer

Question 11

Name 5 elements of stoma care a patient should be counselled on?

Answer 11

Different types of bags - go through with stoma care nurse which one is best for you
- Most bags you just empty in the toilet, over time you learn when your stoma is most active so when it’s best to do this
First three months after fitting avoid heavy lifting
Can still do sport (incl swimming, adhesive is waterproof) but avoid heavy contact
Diet - high fluid and fibre, have dietician who will help with a food diary if constipated/ high output/ wind

Question 12

Name 3 CI to HRT?

Answer 12

Breast cancer
Stoke/ VTE
Undiagnosed PV bleed